Majority of providers do best for patients

To the editor:

I was dismayed to read the “Our opinion” editorial in the Oct. 18 Herald-Star entitled “U.S. should not promote opioids.” This editorial cites a quotation from Sen. Shelley Moore Capito, R-W.Va.: “Under Medicare’s current reimbursement policy, the cost disparity between opioid-based pain medication and non-opioid drugs used to treat post-surgical pain creates a disincentive for providers to use the less addictive, non-opioid alternative,” and goes on to say that she believes that a critical aspect of the battle against drug abuse “is ensuring that the Medicare program does not create a perverse incentive for doctors to continue to prescribe opioids to patients.”

While I agree that there is a huge opioid problem nationally and locally, I challenge Capito and the Herald-Star to provide evidence that there are financial or other incentives for providers (doctors, physician assistants, nurse practitioners, etc.) to prescribe opioids to patients.

There is no difference in my reimbursement if I prescribe Motrin vs. Vicodin to a patient for pelvic pain, for example. Providers do not make more money depending on the medication prescribed.

I also take issue with the fact that Capito believes that post-surgical patients should not be provided opioid-based pain medication.

While I agree that not every surgical procedure warrants opioid-based medication post-operatively, post-operative pain management after major surgical procedures is one of the clear indications for prescribing a short course of opiates to patients.

It would be unethical, in fact, to send a patient home after a major surgical procedure with only Motrin and Tylenol and tell them “this should be good enough to manage your pain,” knowing that it probably would not be adequate. I certainly wouldn’t want to be that patient.

A few years ago, it was government agencies that criticized and even penalized doctors for not managing pain adequately, for not prescribing enough opiates to patients experiencing pain.

In fact, many states mandated continuing medical education hours regarding “pain management” that providers needed to take in order to renew their professional licenses. Licensing boards and agencies believed that providers weren’t treating pain adequately. Mandating prescribing practices like this has contributed to the “opioid crisis.” Now the government wants us not to prescribe opiates even in appropriate circumstances.

I agree that the “pill mills” should be shut down. I agree that providers who profit from selling opiates in their office should be disciplined or shut down. However, the vast majority of us do not sell opiates from our offices. The vast majority of providers are trying to do their best for their patients. The vast majority of providers work hard to prescribe opiates in a responsible manner, particularly now that doctors are being scrutinized and sometimes unfairly charged with crimes. It’s unfair to publish statements that vilify physicians without backing these statements up with facts.

Dr. Tina Cutone